Angiomyolipoma managed by partial nephrectomy: Outcomes and follow-up
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Angiomyolipoma managed by partial nephrectomy: Outcomes and follow-up - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2020.086, Indian Journal of Pathology and Oncology-Indian J Pathol OncolKeywords:
Angiomyolipoma
Clinical pathology
Objectives: To examine the medium‐term functional outcomes of partial nephrectomy for clinical T1b renal cell carcinoma, and to compare them with those of radical nephrectomy for clinical T1b and with those of partial nephrectomy for clinical T1a tumors. Methods: The participants of this study were patients operated for clinical T1a and clinical T1b tumors operated at Tokyo Women's Medical University, Tokyo, Japan, between January 1979 and June 2011. A total of 67 patients underwent partial nephrectomy for clinical T1b tumor, 195 patients underwent radical nephrectomy for clinical T1b tumors and 324 underwent partial nephrectomy for clinical T1a tumors. The outcomes of these three groups were compared. Results: Partial nephrectomy provided better preservation of residual renal function compared with radical nephrectomy for clinical T1b, and the postoperative estimated glomerular filtration rate was similar in the patients who underwent partial nephrectomy for clinical T1b and those who underwent partial nephrectomy for clinical T1a. Postoperative renal function was steadily maintained after partial nephrectomy during the medium‐term follow up. The probability of freedom from new onset of chronic kidney disease after partial nephrectomy for clinical T1b tumors was significantly higher from that after radical nephrectomy for clinical T1b tumors, and similar to that after partial nephrectomy for clinical T1a tumors. Conclusions: The higher anatomical complexity of clinical T1b tumors is unlikely to provide a significant influence on postoperative renal function after partial nephrectomy, when compared with the clinical T1a tumors. These findings support the beneficial role of partial nephrectomy in the preservation of renal function of clinical T1b renal cell carcinoma patients undergoing surgery.
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Objective To study the methods for diagnosis and treatment of renal angiomyolipoma with spontaneous rupture.Methods The clinical data of 13 cases with renal angiomyolipoma rupture in our hospital were reviewed.All the patients were examined by ultrasonography.Ten of those were examined by CT scanning and three were examined by MRI.Eight received nephrectomy,five received partial nephrectomy,one of those received partial nephrectomy in other side renal after one side renal had received partial nephrectomy.Results Thirteen patients undergone surgical operation restored to health smoothly,the 5 patients received partial nephrectomy were heathy and had normal renal function.Conclusion Ultrasound is helpful to the diagnosis,CT scanning and MRI is the best diagnostic procedure which may confirm the character of the lesion and the range of bleeding.If the tumour exceeds 4cm,active treatment should be considered.Any operative management should preserve the functional nephrons as much as possible.Partial nephrectomy is a better choise for treatment of renal angiomyolipoma with spontaneous rupture.
Angiomyolipoma
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Angiomyolipoma is a benign neoplasm composed of varying admixtures of blood vessels, smooth muscle cells, and adipose tissue. Because of an increased risk of spontaneous haemorrhage, surgical approach is needed greater than 4–8 cm size. We here report our partial nephrectomy experience in the 24 cm size giant angiomyolipoma. 26-year-old woman referred to our clinic with a 24 cm size angiomyolipoma in her lower pole of right kidney. The inferior vena cava was deviated to the left by the mass. All the blood tests were normal and we offered her the choices of partial nephrectomy or nephrectomy. Right subcostal approach was used. The patient underwent resection of the mass with a safety region of 1 cm. Frozen section evaluation was consistent with angiomyolipoma and free for surgical margin. Warm ischemia time was 35 min. and intraoperative bleeding volume was 200 cc. Postoperative 2nd day the drain was taken and hospital stay was 4 days. In literature we observed very rare angiomyolipoma cases with such a large dimension treated by partial nephrectomy without arterial embolization. If technically suitable partial nephrectomy is the main chioce in this kind of benign lesions in young patients.
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No AccessJournal of UrologyAdult Urology1 Mar 2012National Trends in the Use of Partial Nephrectomy: A Rising Tide That Has Not Lifted All Boats Sanjay G. Patel, David F. Penson, Baldeep Pabla, Peter E. Clark, Michael S. Cookson, Sam S. Chang, S. Duke Herrell, Joseph A. Smith, and Daniel A. Barocas Sanjay G. PatelSanjay G. Patel Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , David F. PensonDavid F. Penson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee Vanderbilt University Medical Center, Tennessee Valley Veterans Administration Health System, Nashville, Tennessee , Baldeep PablaBaldeep Pabla Vanderbilt University School of Medicine, Nashville, Tennessee , Peter E. ClarkPeter E. Clark Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , Michael S. CooksonMichael S. Cookson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , Sam S. ChangSam S. Chang Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , S. Duke HerrellS. Duke Herrell Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , Joseph A. SmithJoseph A. Smith Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , and Daniel A. BarocasDaniel A. Barocas Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee View All Author Informationhttps://doi.org/10.1016/j.juro.2011.10.173AboutFull TextPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Treatment of organ confined renal masses with partial nephrectomy has durable oncologic outcomes comparable to radical nephrectomy. Partial nephrectomy is associated with lower risk of chronic kidney disease and in some series with better overall survival. We report a contemporary analysis on national trends of partial nephrectomy use to determine partial nephrectomy use over time, and whether nontumor related factors such as structural attributes of the treating institution or patient characteristics are associated with the underuse of partial nephrectomy. Materials and Methods: We performed an analysis of the NIS (National Inpatient Sample), which contains 20% of all United States inpatient hospitalizations. We included patients who underwent radical or partial nephrectomy for a renal mass between 2002 and 2008. Survey weights were applied to obtain national estimates of nephrectomy use and to evaluate nonclinical predictors of partial nephrectomy. Results: A total of 46,396 patients were included in the study for a weighted sample of 226,493. There was an increase in partial nephrectomy use from 15.3% in 2002 to 24.7% in 2008 (p <0.001). 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Isotani S, Shimoyama H, Yokota I, China T, Hisasue S, Ide H, Muto S, Yamaguchi R, Ukimura O and Horie S (2015) Feasibility and accuracy of computational robot‐assisted partial nephrectomy planning by virtual partial nephrectomy analysisInternational Journal of Urology, 10.1111/iju.12714, VOL. 22, NO. 5, (439-446), Online publication date: 1-May-2015. Tan H, Meyer A, Kuo T, Smith A, Wheeler S, Carpenter W and Nielsen M (2014) Provider‐based research networks and diffusion of surgical technologies among patients with early‐stage kidney cancerCancer, 10.1002/cncr.29144, VOL. 121, NO. 6, (836-843), Online publication date: 15-Mar-2015. Kriegmair M, Mandel P, Rathmann N, Diehl S, Pfalzgraf D and Ritter M (2015) Open Partial Nephrectomy for High-Risk Renal Masses Is Associated with Renal Pseudoaneurysms: Assessment of a Severe Procedure-Related ComplicationBioMed Research International, 10.1155/2015/981251, VOL. 2015, (1-7), . Sivarajan G, Taksler G, Walter D, Gross C, Sosa R and Makarov D (2015) The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial NephrectomyMedical Care, 10.1097/MLR.0000000000000259, VOL. 53, NO. 1, (71-78), Online publication date: 1-Jan-2015. Pignot G, Méjean A, Bernhard J, Bigot P, Timsit M, Ferriere J, Zerbib M, Villers A, Mouracade P, Lang H, Bensalah K, Couapel J, Rigaud J, Salomon L, Bellec L, Soulié M, Vaessen C, Roupret M, Baumert H, Gimel P and Patard J (2014) The use of partial nephrectomy: results from a contemporary national prospective multicenter studyWorld Journal of Urology, 10.1007/s00345-014-1279-4, VOL. 33, NO. 1, (33-40), Online publication date: 1-Jan-2015. Monn M, Bahler C, Flack C, Dube H and Sundaram C (2014) The Impact of Hospital Volume on Postoperative Complications Following Robot-Assisted Partial NephrectomyJournal of Endourology, 10.1089/end.2014.0265, VOL. 28, NO. 10, (1231-1236), Online publication date: 1-Oct-2014. Autorino R, Zargar H and Kaouk J (2014) Robotic-assisted laparoscopic surgery: recent advances in urologyFertility and Sterility, 10.1016/j.fertnstert.2014.05.033, VOL. 102, NO. 4, (939-949), Online publication date: 1-Oct-2014. Couapel J, Bensalah K, Bernhard J, Pignot G, Zini L, Lang H, Rigaud J, Salomon L, Bellec L, Soulié M, Vaessen C, Rouprêt M, Jung J, Mourey E, Bigot P, Bruyère F, Berger J, Ansieau J, Gimel P, Salome F, Hubert J, Pfister C, Baumert H, Timsit M, Méjean A and Patard J (2013) Is there a volume–outcome relationship for partial nephrectomy?World Journal of Urology, 10.1007/s00345-013-1213-1, VOL. 32, NO. 5, (1323-1329), Online publication date: 1-Oct-2014. Valerio M, El-Shater Bosaily A, Emberton M and Ahmed H (2014) Defining the level of evidence for technology adoption in the localized prostate cancer pathwayUrologic Oncology: Seminars and Original Investigations, 10.1016/j.urolonc.2013.10.008, VOL. 32, NO. 6, (924-930), Online publication date: 1-Aug-2014. Wiener S, Kiziloz H, Dorin R, Finnegan K, Shichman S and Meraney A (2014) Predictors of Postoperative Decline in Estimated Glomerular Filtration Rate in Patients Undergoing Robotic Partial NephrectomyJournal of Endourology, 10.1089/end.2013.0640, VOL. 28, NO. 7, (807-813), Online publication date: 1-Jul-2014. Laviana A and Hu J (2014) Current controversies and challenges in robotic-assisted, laparoscopic, and open partial nephrectomiesWorld Journal of Urology, 10.1007/s00345-014-1277-6, VOL. 32, NO. 3, (591-596), Online publication date: 1-Jun-2014. Liu J, Leppert J, Maxwell B, Panousis P and Chung B (2014) Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database11Financial Support: JTL is supported by Award no. DK089086 from the National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).Urologic Oncology: Seminars and Original Investigations, 10.1016/j.urolonc.2013.09.012, VOL. 32, NO. 4, (473-479), Online publication date: 1-May-2014. 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Smaldone M and Kutikov A (2012) Assessing the management of localized kidney cancerNature Reviews Urology, 10.1038/nrurol.2012.45, VOL. 9, NO. 4, (186-188), Online publication date: 1-Apr-2012. Volume 187Issue 3March 2012Page: 816-821 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordskidney neoplasmsphysician's practice patternsnephrectomyMetrics Author Information Sanjay G. Patel Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author David F. Penson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee Vanderbilt University Medical Center, Tennessee Valley Veterans Administration Health System, Nashville, Tennessee More articles by this author Baldeep Pabla Vanderbilt University School of Medicine, Nashville, Tennessee More articles by this author Peter E. Clark Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Galil Medical. More articles by this author Michael S. Cookson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Endo. More articles by this author Sam S. Chang Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Sanofi-Aventis, Endo, Allergan and Centocor Ortho Biotech. More articles by this author S. Duke Herrell Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Aesculap Inc., Covidien Surgical Devices, Veran Medical Tech, Wilex and Galil Medical. More articles by this author Joseph A. Smith Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Steba Pharmaceuticals. More articles by this author Daniel A. Barocas Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Ferring, Dendreon and Allergan. More articles by this author Expand All Advertisement PDF downloadLoading ...
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Malignant epithelioid angiomyolipoma is a recently described rare tumor of the kidney. Its existence has been questioned, however, on the basis of incomplete evidence of malignant behavior, the absence of an associated classic angiomyolipoma component, or the absence of immunoreactivity for HMB-45 in some cases. We describe a case that was HMB-45-positive and arose in association with a classic angiomyolipoma. The patient was treated with a partial nephrectomy. Three years later, she developed rapidly enlarging liver nodules. A fine-needle aspiration of the liver confirmed the presence of pleomorphic epithelioid cells morphologically and immunohistochemically identical to those comprising the primary renal tumor. After two cycles of treatment with doxorubicin, there was a 50% reduction in the size of the tumors with marked improvement in performance status. We believe this case confirms the existence of a malignant epithelioid angiomyolipoma.
Angiomyolipoma
HMB-45
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Partial nephrectomy has been considered an effective and efficient method in the treatment of localized renal cell carcinoma. Herein, we retrospectively review our experience with partial nephrectomy in the treatment of localized renal cell carcinoma and compared it with patients who received radical nephrectomy.From 1982 to 2005, 35 patients who received partial nephrectomy for localized renal cell carcinoma were enrolled in this study. Ten patients were female (28.6%). The median age was 70 years (range, 42-82 years). Sixteen (45.7%) patients had pathologic T1a tumors; 17 (48.6%) patients had pathologic T1b tumors and 2 (5.7%) patients had pathologicT2 tumor (7cm). In the meantime, 128 patients who had T1N0M0 renal cell carcinoma and who received radical nephrectomy were assigned to a control group. Thirty-nine patients (30.5%) were female in this group. The median age was 62 years (range, 30-83 years). The tumor characteristics, location, surgical techniques and patient survival were subsequently compared.The median tumor size in the partial nephrectomy group was 3.9cm (range, 1.5-7.0cm), and it was 4.5cm (range, 1-6.5cm) in radical nephrectomy group. The tumor size was smaller in the partial nephrectomy group (p = 0.003). Themedian follow-up period was 4.38 years (range, 0.05-17.99 years) in the partial nephrectomy group and 5.66 years (range, 0.01-22.25 years) in the radical nephrectomy group. There was no local recurrence or distant metastasis in the partial nephrectomy group. The 5-year overall survival was 85.0% compared with 91.4% in the radical nephrectomy group (p = 0.126). The 5-year disease specific survival in the partial nephrectomy group was 100%. The postoperative serum creatinine level increased to >2.0mg/dL in 5 (14.3%) patients in the partial nephrectomy group, but no patient needed hemodialysis during follow-up.From our review, partial nephrectomy is safe and provides excellent disease control in the treatment of localized renal cell carcinoma in selected patients. Renal function preservation was observed in the partial nephrectomy group, while the operated kidney showed functioning in the follow-up nuclear medicine survey.
Distant metastasis
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Cystic neoplasms of the kidney are quite rare. Because they contain various differential diagnoses and their radiological features are not specific, their diagnosis is very difficult except for histopathological data. Usually, they can be confused radiologically with benign cysts of the kidney or angiomyolipoma. Radical or partial nephrectomy is the most commonly preferred curative treatment method when it shows features like rapidly growing or malignancy. Histopathological examination is required for definitive diagnosis. In this article, we aimed to present a rare case of tubulocystic renal cell carcinoma after partial nephrectomy in our clinic, who was followed up in another center for years with the pre-diagnosis of angiomyolipoma, in the light of the literature.
Angiomyolipoma
Histopathological examination
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Purpose of review Provider volume has been shown to affect outcomes of various surgical procedures. Because of its technical complexity, it is likely that partial nephrectomy outcomes can be affected by hospital and/or surgeon volume. However, until recently, there were few publications on the subject. Our objective is to discuss recent findings on the impact of surgical volume on partial nephrectomy outcomes. Recent findings Two studies found a link between the number of partial nephrectomy performed at an institution and postoperative outcomes. Data extrapolated from articles on learning curve of laparoscopic partial nephrectomy suggest that surgeon volume can also affect partial nephrectomy outcomes. Partial nephrectomy is underused in low-volume centers. Robotic partial nephrectomy has a shorter learning curve compared to laparoscopic partial nephrectomy and may increase the use of partial nephrectomy vs. radical nephrectomy. Results on the impact of provider volume on the surgical approach are conflicting. Summary There are few publications suggesting an impact of hospital volume on partial nephrectomy outcomes but the importance of the surgeon volume remains unclear. Higher surgical volume is associated with increased use of partial nephrectomy.
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Angiomyolipoma is a well-known rare soft tissue tumor involving the kidneys, liver and other organs. Long believed to be a benign hamartoma, angiomyolipoma is now considered a neoplasm that arises from perivascular epithelioid cell. Epithelioid angiomyolipoma is potentially malignant variant of angiomyolipoma characterized by epithelioid cells that mimic mal ignant tumors arising from the organs. Immunoreactivity with HMB-45 is helpful for its identification. It is now considered to be a part of PEComa family and perivascular epithelioid cells (PEC) are recently proposed to be its most common progenitor cells. Here we give an overview of five rare cases with epithelioid angiomyolipoma, one in left upper retroperitoneum, two in liver and two in kidney, focusing on clinical presentations and imaging findings. The case in left upper retroperitoneum was pre-operative differentiated from retroperitoneal liposarcoma due to huge space-occupying lesion of uncertain origin. The two cases in kidneys were clinically manifested as palpable abdominal mass and/or acute abdominal pain; both were pre-operative diagnosed by tumoral fat content and/or the classic clinical features. One case with maliganant epithelioid angiomyolipoma of kidney associated with tuberous sclerosis (TS) developed metastases to liver and retroperitoneum and finally died of the disease. The two cases of hepatic epithelioid angiomyolipoma were pre-operative misdiagnosed as hepatocellular carcinoma (HCC) due to its rare incidence and less fat component of the tumor with similar imaging finding to HCC. In conclusion, we radiologists should be aware of the existence of rare epithelioid variant of angiomyolipoma which belongs to the PEComa family arising in different origins and its potential malignant behavior.
Angiomyolipoma
HMB-45
Hamartoma
Perivascular Epithelioid Cell
Angiolipoma
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